Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial.
BACKGROUND
Experimental and clinical work has suggested that hypertonic saline (HTS) would be better than lactated Ringer's solution (LRS) for the resuscitation of patients with head injuries. No clinical study has examined the effect of HTS infusion on intracranial pressure (ICP) and outcome in patients with head injuries. We hypothesized that HTS infusion would result in a lower ICP and fewer medical interventions to lower ICP compared with LRS.


METHODS
Prospective, randomized clinical trial at two teaching hospitals.


RESULTS
Thirty-four patients were enrolled and were similar in age and Injury Severity Score. HTS patients had a lower admission Glasgow Coma Scale score (HTS: 4.7+/-0.7; LRS: 6.7+/-0.7; p = 0.057), a higher initial ICP (HTS: 16+/-2; LRS: 11+/-2; p = 0.06), and a higher initial mean maximum ICP (HTS: 31+/-3; LRS: 18+/-2; p < 0.01). Treatment effectively lowered ICP in both groups, and there was no significant difference between the groups in ICP at any time after entry. HTS patients required significantly more interventions (HTS: 31+/-4; LRS: 11+/-3; p < 0.01). During the study, the change in maximum ICP was positive in the LRS group but negative in the HTS group (LRS: +2+/-3; HTS: -9+/-4; p < 0.05).


CONCLUSIONS
As a group, HTS patients had more severe head injuries. HTS and LRS used with other therapies effectively controlled the ICP. The widely held conviction that sodium administration will lead to a sustained increase in ICP is not supported by this work.
Shackford
S R
SR
Department of Surgery, College of Medicine, University of Vermont, Burlington, USA. sshackfo@salus.med.uvm.edu
Bourguignon
P R
PR
Wald
S L
SL
Rogers
F B
FB
Osler
T M
TM
Clark
D E
DE
D000328:Adult; D006259:Craniocerebral Trauma / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007427:Intracranial Pressure / Q000187:drug effects; D007552:Isotonic Solutions / Q000737:chemistry / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic / Q000737:chemistry / Q000627:therapeutic use*
D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic